Provider Demographics
NPI:1487746111
Name:STEPHENS, EDWARD M (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WINDWARD AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5307
Mailing Address - Country:US
Mailing Address - Phone:914-686-9075
Mailing Address - Fax:212-737-8279
Practice Address - Street 1:12 WINDWARD AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5307
Practice Address - Country:US
Practice Address - Phone:914-686-9075
Practice Address - Fax:212-737-8279
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYMD1073392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
113428OtherVALUE OPTIONS
674702OtherBLUE CROSS BLUE SHIELD
C11718Medicare UPIN
113428OtherVALUE OPTIONS
674701Medicare UPIN